Metastasis-directed therapy (MDT) is increasingly being used in oligometastatic castration-sensitive prostate cancer (omCSPC). However, it is currently unclear how to optimally integrate MDT with the standard of care of systemic hormonal therapy.
To report long-term outcomes of MDT alone versus MDT and a defined course of androgen deprivation therapy (ADT) in omCSPC.
Here, a multicenter, international retrospective cohort of omCSPC as defined by conventional imaging was reported.
Biochemical progression-free survival (bPFS), distant progression-free survival (dPFS), and combined biochemical or distant progression-free survival (cPFS) were evaluated with Kaplan-Meier and multivariable Cox proportional hazard regression models.
A total of 263 patients were included, 105 with MDT + ADT and 158 with MDT alone. The majority of patients had metachronous disease (90.5%). Five-year bPFS, dPFS, and cPFS were, respectively, 24%, 41%, and 19% in patients treated with MDT + ADT and 11% (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.36-0.64), 29% (HR 0.56, 95% CI 0.40-0.78), and 9% (HR 0.50, 95% CI 0.38-0.67) in patients treated with MDT alone. On a multivariable analysis adjusting for pretreatment variables, the use of ADT was associated with improved bPFS (HR 0.43, p < 0.001), dPFS (HR 0.45, p = 0.002), and cPFS (HR 0.44, p < 0.001).
In this large multi-institutional report, the addition of concurrent ADT to MDT appears to improve time to prostate-specific antigen progression and distant recurrence, noting that about 10% patients had durable control with MDT alone. Ongoing phase 3 studies will help further define treatment options for omCSPC.
Here, we report a large retrospective review evaluating the outcomes of metastasis-directed therapy with or without a limited course of androgen deprivation for patients with oligometastatic castration-sensitive prostate cancer. This international multi-institutional review demonstrates that the addition of androgen deprivation therapy to metastasis-directed therapy (MDT) improves progression-free survival. While a proportion of patients appear to have long-term disease control with MDT alone, further work in biomarker discovery is required to better identify which patients would be appropriate for de-escalated therapy.
European urology oncology. 2024 Apr 02 [Epub ahead of print]
Matthew P Deek, Philip Sutera, Yuezhou Jing, Robert Gao, Emily Rothman, Heather Day, David Chang, Piet Dirix, Andrew J Armstrong, Bethany Campbell, Fernando Lopez Campos, Miguel Berenguer, Matthew Ramotar, Antonio Conde-Moreno, Alejandro Berlin, Davide Giovanni Bosetti, Niall Corcoran, Bridget Koontz, Carole Mercier, Shankar Siva, David Pryor, Piet Ost, Mai Anh Huynh, Stephanie Kroeze, Bradley Stish, Ana Kiess, Bruce Trock, Phuoc T Tran, Silke Gillessen, Christopher Sweeney
Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA., Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA., The James Buchanan Brady Urological Institute of Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Department of Radiation Oncology, The Mayo Clinic, Rochester, MN, USA., Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, USA., Department of Radiation Oncology, Australian Prostate Cancer Research Center, Queensland, Australia., Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia., Department of Radiation-Oncology, GasthuisZusters Antwerp (GZA) 'Sisters of the Hospital', Antwerp, Belgium., Department of Medicine, Division of Medical Oncology, Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University Medical Center, Durham, NC, USA., Urology Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia., Department of Radiation Oncology, Hospital Ramón y Cajal, Madrid, Spain., Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada., Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland., GenesisCare US, Fort Myers, FL, USA., Department of Human Structure and Repair, Ghent University, Ghent, Belgium., Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland., Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA., South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/38570239